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Background:
Reoperative coronary artery bypass (redo-CAB) surgery can be challenging procedures due to increased adhesions, target vessel identification and postoperative bleeding. In this study, we examine the role of reoperative off-pump coronary artery bypass surgery (redo-OPCAB) in this patient population compared to redo-CAB patients performed with cardiopulmonary bypass (CPB).
Methods:
We analysed the Society of Thoracic Surgeons (STS) database input for all patients undergoing their second CAB surgery at our institution, from January 2004 to June 2011. A total of 267 patients were included, 62 of which were in the redo-OPCAB group. Logistic and linear regression analysis was performed to assess whether CPB was an independent predictor of postoperative outcomes.
Results:
Baseline characteristics of the two groups (redo-CAB= 205 patients, redo-OPCAB=62) were similar including mean age, pre-operative ejection fraction and creatinine level, as well as other pre-operative risk factors captured by STS database. There was a trend for increased number of diseased vessels in the redo-CAB group compared to redo-OPCAB (2.44 vs 2.66). No difference was noted in individual outcomes of hours of mechanical ventilation, stroke, renal failure or 30-day mortality between the two groups. Regression analysis showed that redo-OPCAB had less composite outcome post-operative complications (category of STS database), decreased ICU hours and decreased length of stay from surgery to discharge (p <0.05).
Conclusions: Redo-OPCAB seems to offer favorable outcomes compared to redo-CAB in reoperative coronary patients.